September 25, 2013

Acetaminophen receipt among HIV-infected patients with advanced hepatic fibrosis

Pharmacoepidemiology and Drug Safety

Early View (Online Version of Record published before inclusion in an issue)

Brief Report

E. Jennifer Edelman1,2,‡,*, Kirsha S. Gordon3,‡, Vincent Lo Re III4,5, Melissa Skanderson3,6, David A. Fiellin1,2, Amy C. Justice1,2,3, for the VACS Project Team

Article first published online: 22 SEP 2013

DOI: 10.1002/pds.3517

Copyright © 2013 John Wiley & Sons, Ltd.

Keywords: acetaminophen; HIV; hepatitis C; Veterans; medication; pharmacoepidemiology



HIV-infected patients may be at particular risk for acetaminophen-induced hepatotoxicity, but acetaminophen use in the context of liver injury has been incompletely examined among HIV-infected patients. Among a sample of HIV-infected patients, we aimed to determine acetaminophen exposure, assess the cross-sectional association between acetaminophen exposure and advanced hepatic fibrosis, and determine whether factors associated with acetaminophen exposure varied by HCV status.


We conducted a cross-sectional analysis of the Veterans Aging Cohort Study. Advanced hepatic fibrosis was defined as a FIB-4 > 3.25, a composite score calculated based on age, alanine aminotransferase, aspartate aminotransferase, and platelet count. Multivariable ordered polytomous logistic regression was used to determine the association between FIB-4 status and acetaminophen exposure stratified by HCV status.


Among HIV-infected patients (n = 14 885), 31% received at least one acetaminophen prescription. Among those receiving acetaminophen, acetaminophen overuse was common among both HIV-monoinfected and HIV/HCV-coinfected patients (846 [31%] vs 596[32%], p = 0.79). After stratifying by HCV status, those with evidence of advanced liver fibrosis were equally likely to be exposed to acetaminophen. Furthermore, HIV-monoinfected patients with an alcohol use disorder were more likely to have acetaminophen overuse (OR [95%CI] = 1.56 [1.21–2.02]).


Strategies to minimize acetaminophen exposure, especially for HIV-monoinfected patients, are warranted. Copyright © 2013 John Wiley & Sons, Ltd.


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